Provider Demographics
NPI:1023288081
Name:EAGLE FAMILY VISION, INC
Entity type:Organization
Organization Name:EAGLE FAMILY VISION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-573-9501
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:3650 EAGLE CREEK DRIVE
Mailing Address - City:MONT BELVIEU
Mailing Address - State:TX
Mailing Address - Zip Code:77580-0147
Mailing Address - Country:US
Mailing Address - Phone:281-573-9501
Mailing Address - Fax:
Practice Address - Street 1:3650 EAGLE CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:MONT BELVIEU
Practice Address - State:TX
Practice Address - Zip Code:77580-0147
Practice Address - Country:US
Practice Address - Phone:281-573-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty